Current and future public health is characterized by the increase of chronic and degenerative diseases, corresponding to the worldwide ageing of the population. The increasing prevalence of these conditions together with the long incubation period of the chronic diseases and the continual technological innovations, offer new opportunities to develop strategies for early diagnosis.
Public Health has an important mandate to critically assess the promises and the pitfalls of disease screening strategies. This MOOC will help you understand important concepts for screening programs that will be explored through a series of examples that are the most relevant to public health today. We will conclude with expert interviews that explore future topics that will be important for screening.
By the end of this MOOC, students should have the competency needed to be involved in the scientific field of screening, and understand the public health perspective in screening programs.
This MOOC has been designed by the University of Geneva and the University of Lausanne.
This MOOC has been prepared under the auspices of the Ecole romande de santé publique (www.ersp.ch) by Prof. Fred Paccaud, MD, MSc, Head of the Institute of Social and Preventive Medicine in Lausanne (www.iumsp.ch), in collaboration with Professor Antoine Flahault, MD, PhD, head of the Institute of Global Health, Geneva (https://www.unige.ch/medecine/isg/en/) and Prof. Gillian Bartlett-Esquilant (McGill University, Quebec/ Institute of Social and Preventive Medicine, Lausanne).

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Screening in Low and Middle-Income Countries and Migrants

The globalization of non-communicable diseases is a major challenge in low and middle income countries (LMIC). At the same time, migration is occurring between these countries and high income countries. Screening for cardiovascular diseases and for cancer in low and middle income countries will be presented and discussed. In addition, the special consideration of screening of migrants from these countries will be addressed. This module is given by: Professor Pascal Bovet from the Division of Chronic Diseases at the Institute of Social and Preventive Medicine in Lausanne; Dr. Catherine Sauvaget from the International Agency for Research on Cancer (IARC) in Lyon, France; and Professor Patrick Bodenmann from the Polimedical University Clinic and head of the Centre for Vulnerable Populations. A quiz will complete this module.

Conheça os instrutores

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

Fred Paccaud (In Partnership with UNIGE)

Professor of epidemiology and public health and Director of the Institute of social and preventive medicineLausanne University Hospital

Gillian Bartlett-Esquilant

Professor of Epidemiology and Research and Graduate Program Director and Associate Chair for the Department of Family Medicine at McGill University.University of Lausannne and McGill University

[MUSIC]

Good morning, my name is Pascal Bovet.

I'm a medical doctor and specialist in public health.

I work in the Institute of Preventive Medicine in the University of Lausanne.

And I've been also often involved with the World Health Organization.

And I work quite often with different developing countries in relation to

noncommunicable disease.

The topic of this session is about public health surveillance of high risk

strategy to curb noncommunicable disease in low and middle-income countries.

It is known to all of us, I suppose,

that noncommunicable disease are increasing worldwide.

And as the slide shows, it is a major contributive factor for

total burden of mortality in high-income countries.

But it is increasingly so, also in low and middle income countries.

And actually, as the slide shows, there are more

cases of death of noncommunicable disease in low and

middle income countries as compared to high income countries.

And again, these numbers are going to increase.

And the increase is mostly related to the fact that the population in most countries

and in particular, in low and middle income countries, is increasing.

Noncommunicable disease has been recognized as a major health problem

worldwide.

But also, increasingly so as a major economic problem.

And the cost of noncommunicable disease over the next

15 years has been evaluated to $7 trillion.

Action to combat this noncommunicable disease is

estimated to $170 billion for the next 15 years.

Therefore, controlling and preventing noncommunicable disease has a cost,

but inaction will be much more costly.

And therefore, we have to identify and implement

appropriate strategies to address the burden of noncommunicable disease.

As the slide shows here,

we can say that there are four main noncommunicable disease.

Heart disease and stroke, diabetes, cancer, and chronic lung disease.

And that these four diseases share four common risk factors.

That's what is called the four by four strategies.

Four risk factors account for

much for noncommunicable disease.

So when addressing prevention and control of noncommunicable disease,

we generally speak of two possible strategies.

One is called the population wide strategy.

And the other one is called the high risk strategy.

Now the slide here shows the main characteristics of both of them.

The population strategy generally aims at reducing risk

factors in the entire population through public health intervention.

For example, when you put less salt in tuna can,

this will brings a bit less salt to everyone in the population.

And there's no need for cooperation for persons, as everyone will

have less salt by eating these boxes of tuna cans.

So population strategies have a big advantage.

They do not need, necessarily, the cooperation of people to make a change.

So these are ideal strategies to address noncommunicable disease.

Yet there are people who have problems already.

They have high blood pressure, they have hypertension, they have diabetes.

And these people need to be treated, and that is called the high risk strategy.

The idea in the high risk strategy is to look and find people who have the problem.

And when these people have been identified, we have to treat them.

It is obvious from these premises of this strategy

that we need cooperation of people.

People have to agree with the intervention, they will have to agree

to have something measured, and to take some medication at some point.

And in general as well, this strategy will require medication.

And therefore, this strategy is generally quite expensive

because we have to find people, we have to give treatment.

And in the case of noncommunicable disease,

treatment has generally to be given for life.

Therefore the cost is very high over life.

This module is really about high-risk strategy, and

I will give a little bit more information about that strategy a bit later on.

Okay, with these different introductory slides, we have an examined

the two different strategies to address noncommunicable disease.

Population wide and high-risk strategies.

The module is about high risk strategies, but it was important to realize how